PAID IN TEETH
Consent form... sign your life away
Full Name
First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Phone Number
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Area Code
Phone Number
Email
example@example.com
Address
Street Address
City
State / Province
Postal / Zip Code
ID#
Instagram @
I understand that I will be required to wear a face covering throughout the entire procedure to safely get tattooed, as required by WorkSafe BC.
Yes
No
I have advised Paid in Teeth of any Covid-19 symptoms I currently have or recently had and any potential exposures.
Yes
No
I have been following the Health and Safety guidelines for Covid-19 set out by the BC Health Ministry. I promise I have not been acting like a Rat Licker and making this pandemic worse.
Yes
No
I have advised Paid in Teeth of any communicable disease that I could transfer, including but not limited to the flu, common cold, HIV/AIDS or hepatitis
Yes
No
I have educated myself of all risks associated with getting tattooed. I fully understand that these risks, known and unknown, can lead to injury, including but not limited to infection, scarring, difficulties in the detection of melanoma, and allergic reactions to tattoo pigment and/or soap. And I expressly assume any & all risks that may arise from tattooing.
Yes
No
I do not have any medical or skin conditions that may interfere with the procedure, application or healing of the tattoo. This may include, diabetes, epilepsy, hemophilia, or any heart conditions. I do not take medication that thins my blood. I do not have a mental impairment that may affect my judgement in getting the tattoo.
Yes
No
I am not under the influence of alcohol or drugs, and I am voluntarily submitting to be tattooed without duress or coercion. I confirm I will not be under the influence while getting tattooed. I legally declare I am 18 or older.
Yes
No
I understand that this procedure is a permanent change to my skin and body.
Yes
No
I allow my tattoo to be photographed and be used for Paid in Teeth social media / promo /portfolio.
Yes
No
I acknowledge that Paid In Teeth does not offer refunds.
Yes
No
I agree that Paid In Teeth does not have a way of identifying if I am allergic to the elements or ingredients that will be used for my tattoo. I have informed Paid in Teeth of any allergies or sensitivities to products I'm aware of.
Yes
No
I understand that I need to take care of the tattoo by following the instructions given to me by Paid In Teeth.
Yes
No
I understand that I might get an infection if I don't follow the instructions given to me in regards of taking good care of my tattoo.
Yes
No
I indemnify and hold harmless Paid In Teeth against any claims, expenses, damages, and liabilities.
Yes
No
I understand that if my tattoo does not heal well, I will be charged for touch-ups or a second session. I understand this can range from $20.00, for a small touchup, to the full rate, especially if I do not take care of my tattoo. This rate is entirely subject to Paid in Teeth's discretion.
Yes
No
I acknowledge that I have been given adequate opportunity to read and understand this document. I confirm that the information I provided in this document is accurate and true. I understand that by clicking 'submit' I am signing a legal contract.
Yes
No
Signed Date
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Month
-
Day
Year
Date
Client Signature
Submit
Should be Empty: